Classification systems of communication for use in epidemiological surveillance of children with cerebral palsy

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  • Daniel Virella, Epidemiology and Statistics Office of the Research Unit and Área de Pediatria Médica do Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.
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  • Lindsay Pennington, Institute of Health and Society, Royal Victoria Infirmary, Sir James Spence Institute, Newcastle University, Newcastle-upon-Tyne, UK.
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  • Guro L Andersen, The Cerebral Palsy Register of Norway, Vestfold Hospital Trust and Department of Laboratory Medicine, Women's and Children's Health, The Norwegian University of Science and Technology, Trondheim, Norway.
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  • Maria da Graça Andrada, Federação das Associações Portuguesas de Paralisia Cerebral, Avenida Rainha Dona Amélia, Lisbon, Portugal.
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  • Andra Greitane, Rehabilitation Center 'Mes esam lidzas', Riga, Latvia.
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  • Kate Himmelmann, University of Gothenburg
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  • Audrone Prasauskiene, Children's Rehabilitation Hospital affiliated to the Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania.
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  • Gija Rackauskaite
  • Javier De La Cruz, Clinical Research Unit, Imas12-Ciberesp, Hospital 12 Octubre, Madrid, Spain.
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  • Allan Colver, Institute of Health and Society, Royal Victoria Infirmary, Sir James Spence Institute, Newcastle University, Newcastle-upon-Tyne, UK.
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  • Surveillance of Cerebral Palsy in Europe Network

AIM: Children with cerebral palsy (CP) often experience communication difficulties. We aimed to identify a classification system for communication of children with CP suitable for epidemiological surveillance.

METHOD: Systems to classify the communication of children with CP were identified. The Communication Function Classification System (CFCS), Functional Communication Classification System (FCCS), and Viking Speech Scale (VSS) were chosen for further investigation and translated. They were administered to 155 children aged 4 to 13 years with CP (across all motor severity levels) from eight European countries. Children's parents/carers, speech therapists, and other health professionals applied the systems through direct observation. Other professionals applied them from case notes only. The systems were assessed for agreement, stability, ease, and feasibility of application.

RESULTS: Test-retest stability was moderate-to-high for VSS (k=0.66-0.88), CFCS (k=uncomputed-0.91), and FCCS (k=0.52-0.91). Overall interrater agreement was fair to very good for every classification system. VSS achieved the best agreement between parents/carers and speech therapists. VSS was considered the easiest instrument to apply.

INTERPRETATION: Because of its ease of use by a range of healthcare professionals, the VSS should be considered for CP registers which intend to survey speech intelligibility. For a wider assessment of communication, the CFCS or FCC should be considered.

TidsskriftDevelopmental Medicine and Child Neurology
Sider (fra-til)285-91
Antal sider7
StatusUdgivet - mar. 2016


  • Cerebral Palsy, communication

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